Outcome of Early Pregnancy After Bariatric Surgery
Dr. Tereza Indrielle Remesova
Lucy JonesPratik Sufi
Department of Bariatric SurgeryWhittington Hospital London. UK
Background
Increase 800 % (USA)
American Society for Metabolic & Bariatric Surgery / ACOG:
Women after bariatric surgery should delay conception to 12 – 18 months post operatively
150 kg 110kg 85kg
0 months 12 months 18 months
Our cohort2009 - 201120 patients aged 22 – 422 gastric bands, 18 gastric
bypassconceived at 1 week to 42
months after bariatric surgery
MethodsRetrospective data collection
from medical recordssemi-structured telephone
interviews were carried out with most of the patients
• initial reproductive plans• fertility status• contraceptive method• surgical outcome• development of pregnancy and obstetrical
and neonatal outcome
Results - Pregnancies11 primiparas4 women G3, 1 woman G4, 1
woman G5 3 not recorded
17 Singleton
2 Twins
1 Miscarriage (6 weeks)
Results - Conception
16
10 patients Before 12 months
3 patients 12 - 18 months
7 patients 18 – 42 months
non - intentionally
9 3 pill 2 condom 1 implant removed 1 patch 2 nil
Intentionally 0 Non - intentionally
6 no contraception1 pill
intentionally 3
Results - Fertility5 patients thought to be infertile 1 not recorded
9 PCOS
1 Decreased infertility
9 Normal fertility
9 regular
5 irregular
1 Amenorrhoea, resolved after surgery
Complications 2 cases not recorded
3 cases not recorded
1 Placental abruption (38w)1 small-sized placenta1 Hypoglycaemia1 low levels of vit/minerals 3 anaemia
no gestational diabetes (bias?)
5 Uncomplicated pregnancy 1 not recorded
1 PPH 1 IUGR (30w)1 hypertension 1 Anterior abdo wall haematoma 1 pneumonia 1 symptomatic gall stones 5 anaemia1 Ca deffiniciency
no gestational diabetes (bias?)
2 uncomplicated pregnancies
Mode of Delivery 4 cases not recorded / about to give birth
C section (42 %) Emergency4
• Placental abruption• Foetal distress at 42
weeks• Growth failure• Failed induction
Elective2
• Breech• Previous C section
Vaginal (58 %) 10
Neonatal outcome
Average weight of the newborn was 2.94 kg (0.9 – 4 kg) and all babies were healthy at the time of the interview.
NICU – twins with IUGR
1 30 weeks (twins)
14 38 - 41
1 42 weeks
Conclusion Low fertility, increases rapidly
with weight loss -> appropriate counselling
Complications related to obesity and rapid weight loss
Obstetrical outcome satisfactory if well monitored
Neonatal outcomes satisfactory
ConclusionCareful monitoring, MDT
approach
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